Upgrading after radical prostatectomy

UroToday – Prostate Cancer Volume at Biopsy Predicts Clinically Significant Upgrading – Abstract

Preoperative prostate specific antigen greater than 5.0 ng/ml (p = 0.036), prostate weight 60 gm or less (p = 0.004) and more cancer volume at biopsy, defined by cancer involving greater than 5% of the biopsy tissue (p = 0.002), greater than 1 biopsy core (p < 0.001) or greater than 10% of any core (p = 0.014), were associated with pathological upgrading. Upgraded patients were more likely to have extraprostatic extension and positive surgical margins at radical prostatectomy (p < 0.001 and 0.001, respectively).

This study gives some preoperative parameters that may be suggestive of a hogher gleason score after surgery. When prostates are removed, they are analyzed in more detail and a more accurate gleason score is obtained. In my series about 1/3 of gleason 6 prostate cancers are upgraded. I have noticed that tumor volume is related to upgrading similar to these authors.

Prostate Cancer: Obese men are more likely to have worse pathology reports than expected

Dr. Koop – Biopsy Underestimates Prostate Cancer in Overweight Men:

beige_quote.bmpResearchers compared the biopsy grade to the cancer grade following radical prostatectomy, which is the removal of the prostate. In 1,113 men who underwent radical prostatectomy between 1996 and 2005 within the Shared Equal Access Regional Cancer Hospital database, 299 men, or 27 percent, had more severe cancer than suggested by biopsy. In 123 patients, or 11 percent, cancer diagnosis was actually less severe.

This was an interesting study that concluded that obesity is one of the risk factors for upgrading at the time of pathological analysis.
The last time I reviewed my database I found that 30% of my gleason 6 cancers were upgraded to 7. I have not done an analysis to see which patients are more at risk yet.